Healthcare Provider Details

I. General information

NPI: 1619213782
Provider Name (Legal Business Name): LAUREN N FARWICK PT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2012
Last Update Date: 10/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 BONITA RD SUITE 100
CHULA VISTA CA
91910-3263
US

IV. Provider business mailing address

5905 SEVERIN DR
LA MESA CA
91942-3806
US

V. Phone/Fax

Practice location:
  • Phone: 619-422-8315
  • Fax: 619-422-4489
Mailing address:
  • Phone: 619-589-2606
  • Fax: 619-464-0900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number013992
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number39773
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: